Healthcare Provider Details

I. General information

NPI: 1538163373
Provider Name (Legal Business Name): CHARLES F ROSS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

421 N MAIN ST
LEEDS MA
01053-9764
US

V. Phone/Fax

Practice location:
  • Phone: 134-731-6041
  • Fax:
Mailing address:
  • Phone: 413-731-6041
  • Fax: 413-788-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number002466
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1845
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: